经皮微波消融与传统手术治疗子宫肌瘤疗效对比研究

Comparison between percutaneous microwave ablation and traditional surgery in the treatment of hysteromyoma

目的比较经皮微波消融(percutaneous microwave ablation,PMWA)与传统手术治疗子宫肌瘤的临床疗效。方法选取2018年1月至2020年2月在汕头大学医学院第二附属医院行手术治疗的142例子宫肌瘤患者进行回顾性分析,其中PMWA组48例、腹腔镜子宫肌瘤剔除术(laparoscopic myomectomy,LM)组44例、开腹子宫肌瘤剔除术(abdominal myomectomy,AM)组50例。统计PMWA组术后12个月的临床疗效及症状改善程度,并比较3种术式皮肤切口、术中出血量、住院天数、肠道恢复速度以及并发症发生率等指标。结果PMWA组术后子宫肌瘤逐步缩小,临床症状明显改善;术后1、3、6、12个月子宫肌瘤体积缩小率(volume reduction rate,VRR)依次为(43.88±18.90)%、(65.42±18.59)%、(74.47±16.56)%、和(82.39±12.99)%,差异有统计学意义(P<0.001);PMWA组皮肤切口大小、术中出血量、术后1d血红蛋白、总住院天数、术后住院天数以及术后肛门首次排气时间均优于LM组及AM组,差异均有统计学意义(P<0.001);在平均手术时长对比中,PMWA组平均手术时长大于AM组,差异有统计学意义(P<0.05),与LM组对比差异无统计学意义(P>0.05);PMWA组、LM组、AM组术后12个月内并发症发生率分别为4.2%、4.5%、6%,差异无统计学意义(P>0.05)。结论经皮微波消融治疗适中体积的子宫肌瘤疗效确切,与传统手术相比具有创伤小、出血少、住院天数少和术后恢复快等优势,值得临床推荐使用。

Objective To compare the clinical efficacy of percutaneous microwave ablation(PMWA)and traditional surgery in the treatment of hysteromyoma.Methods Totally 142 patients with hysteromyoma who underwent surgery in the Second Affiliated Hospital of Medical College of Shantou University from January 2018 to February 2020 were selected for retrospective analysis,including 48 cases of PMWA,44 cases of laparoscopic myomectomy(LM)and 50cases of abdominal myomectomy(AM).The clinical efficacy and symptom improvement of PMWA group within one year after operation were analysed,and the indexes of skin incision,surgical blood loss,hospital stay time,intestinal recovery speed,and incidence of complications were compared among three treatment groups.Results At 12 months after PMWA,the volume of hysteromyoma reduced gradually and the clinical symptoms improved significantly.The volume reduction rate(VRR)of hysteromyoma at 1,3,6 and 12 months after PMWA was(43.88±18.90)%,(65.42±18.59)%,(74.47±16.56)%and(82.39±12.99)%(P<0.001).The PMWA group was better than LM group and AM group in incision size of skin,blood loss during operation,hemoglobin at one day after operation,total length of hospital stay,postoperative length of hospital stay,and the time of first postoperative anal exhaust,and the difference among them were statistically significant(P<0.001).In the comparison of average operation time,the average operation time in PMWA group was longer than that in LM group,the difference between them being statistically significant(P>0.05);however,there was no significant difference between PMWA group and LM group(P>0.05).Conclusion PMWA is effective in the treatment of moderate-volume hysteromyoma.Compared with traditional surgery,PMWA has the advantages of less trauma,less blood loss,less hospital stay,and rapid postoperative recovery.It is worthy of clinical recommendation and application.